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General NPI Number Information
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NPI Number | 1669982138
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Entity Type | Individual
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Provider Name | JOSE LEE CASTILLO III LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 777 E TAHQUITZ CANYON WAY STE 200-44
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City | PALM SPRINGS
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State | CA
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Zip | 92262-6784
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Country | US
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Telephone | 760-699-7888
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Fax | 833-907-1198
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Provider Business Mailing Address
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Address Line | 777 E TAHQUITZ CANYON WAY STE 200-44
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City | PALM SPRINGS
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State | CA
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Zip | 92262-6784
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Country | US
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Telephone | 760-699-7888
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Fax | 833-907-1198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 8090730-3506
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 109624
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 109624
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License Number State | CA
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